CAGB术桥血管的选择

CardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.Introduction3血管内径2-3mm，其直径与冠状动脉直径之比1-2:14管壁厚度血管壁厚度＜1mm6带蒂血管最好是带蒂血管，只需行一个远端吻合5不易痉挛7抗压自身有一定的压力承受能力，不易在术后出现纤维化、钙化和粥样硬化1表浅易获取对被取部位的结构和功能不产生明显影响2长度足够足以达到冠状动脉靶血管8通畅能保持良好的远期通畅率理想的桥血管CardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.1.InternalThoracicArteryCardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversityNowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.InternalThoracicArteryCardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.Kolessov施行了第一台成功的ITA冠状动脉搭桥计划手术。1964Goetz施行了第一台成功的CAGB计划手术——使用金属管道连接RITA与RCA。Longmire在冠状动脉内膜切除术失误时，被迫临时行ITA-coronay手术，是直接使用ITA行CAGB的第一例。ArthurMartinVineberg将ITA移植入心肌隧道，利用其侧支出血，改善心脏血运，死亡率6%。195119581960InternalThoracicArtery抗动脉粥样硬化减少了游离过程中内膜细胞的移行，从而减少内皮增生。无孔弹力内膜（内中膜移行处）减少血小板生长因子及脉搏搏动介导的增生反应中层薄/平滑肌细胞少乳内动脉较隐静脉更能抵抗游离时产生的内膜损伤，电镜下几乎看不到成栓性内膜损伤（thrombogenicintimaldefects）这一在静脉桥游离过程中常见的损伤。耐游离损伤CardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.InternalThoracicArtery丰富的扩血管活性成分内皮含大量NO、前列腺素，对术后常用的扩血管药物反应良好，但对缩血管药物的反应较差。独特的内皮“下游”效应内源性分泌物可产生“下游”效应，可对吻合口下游的的冠状动脉起到一定的保护作用。重构ITA内皮在术后随时间推移可发生显著的重构，扩大管径以不断适应心肌的血流灌注需求，而这是在术后随访冠状动脉造影中可以观察到的。CardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.血流调节ITA可以像普通冠状动脉一样调节血流量。InternalThoracicArteryCardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.Betterevent-freesurvivalSuperiorbiologiccharacteristicsUnparalleledlong-termpatencySuperiorearly/latesurvivalFirstChoiceBetterclinicaloutcomesInternalThoracicArteryCardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.术前的乳内动脉造影B超术中游离乳内动脉，术中观察评估方法InternalThoracicArteryCardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.PedicledSkeletonizationvsInternalThoracicArteryCardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.TheJournalofThoracicandCardiovascularSurgerycJuly2016Pedicledandskeletonizedsingleandbilateralinternalthoracicarterygraftsandtheincidenceofsternalwoundcomplications:InsightsfromtheArterialRevascularizationTrial(2056patients/1year)UniversityofBristol&UniversityofOxford&MedicalUniversityofGdansk&NorfolkandNorwichUniversityHospitalsNHSFoundationTrustInternalThoracicArteryCardiavascularSurgeryDepartmentofour1stHospitalofLanzhouUniversitywasfoundedinthe1950s,taketheleadinNorthwestChinatocarryoutthecardiavascularsurgery.Nowisthelargestcardiaccenterinourprovince,wehaveteamofanesthesia,extracorporalcirculation,ultrasoniccardiogramandICUofourown,andnearly1,000caseofoperationwascompletedannually.TheJournalofThoracicandCardiovascularSurgery